1. Medicare 101: The Four Parts

Medicare is divided into four parts:

• Part A covers hospital and inpatient care.
• Part B covers doctor visits and outpatient services.
• Part C (Medicare Advantage) is private insurance that replaces Parts A and B, often bundling in extras like dental or vision.
• Part D helps cover the cost of self-administered prescription drugs.

Parts B, C, and D were introduced later—B in 1965, C in 2003, and D in 2006—to give retirees more options and flexibility in coverage.

2. Who Gets Medicare Part A for Free?

You’re eligible for premium-free Part A if you’ve paid into Medicare through payroll taxes (FICA) for 40 quarters—or 10 years. That’s 1.45% of your income from you and another 1.45% from your employer. If you’re self-employed, you’ve been paying the full 2.90%.

If you don’t meet that 10-year threshold, you can still qualify through a spouse or ex-spouse’s work history—as long as certain conditions like age and marriage duration are met.

High earners (above $200,000 for individuals or $250,000 for joint filers) pay an extra 0.90% Medicare tax on income over those thresholds.

3. When Should You Enroll in Part A?

In many cases, you can delay enrolling in Part A without penalties, especially if you (or your spouse) are still working and have health insurance through an employer with 20 or more employees.

If you have a Health Savings Account (HSA), it’s crucial to delay both Part A and Part B to keep contributing tax-free. Once enrolled in Medicare, HSA contributions must stop.

However, if you’re on COBRA, an individual plan, or a small employer plan (fewer than 20 employees), you must enroll in Part A and B at age 65 to avoid penalties.

4. What Does Part A Cover?

Here’s what you get with Medicare Part A:

• Inpatient hospital care
• Skilled nursing facility care (rehab after a hospital stay)
• Home health care (for recovery—not long-term care)
• Hospice care for terminal illnesses, including pain relief, spiritual support, and up to five days of respite care for family caregivers

5. What Will It Cost You?

If you’ve earned your 40 quarters, your Part A premium is $0. If not:

• 30–39 quarters: $285/month
• Less than 30 quarters: $515/month

And if you delay enrollment without coverage, there’s a 10% penalty for each year of delay, which lasts for twice the length of the delay.

Out-of-pocket costs include:

• A $1,676 deductible per benefit period (not annual!)
• $419/day for hospital stays beyond 60 days
• $838/day after 90 days
• And nothing is covered after 150 days

6. What Medicare Part A Doesn’t Cover

Let’s be clear: Medicare Part A is not full coverage.

• It doesn’t cover long hospital stays past 150 days
• You’ll pay $209.50/day for skilled nursing after 20 days (up to 100)
• And you’re on your own for long-term care, custodial care, and many out-of-pocket hospital charges

7. Why You Need a Supplemental Plan (Medigap)

To fill those gaps, many people choose a Medigap policy. Here’s the quick rundown:

• Plan F: Covers everything but only available if you started Medicare before January 1, 2020
• Plan G: Covers everything except the $257 Part B deductible—and is the most popular plan for new enrollees
• Plan N: Lower premiums, but you’ll pay copays and could face excess charges

Medigap shifts financial risk from you to the insurance company, giving you peace of mind.

8. Don’t Go It Alone—Get the Right Guidance

Whether you’re just turning 65 or helping a loved one through Medicare decisions, it pays to talk to a Medicare guide who can walk you through your options.

At MedicareSchool.com, we help people:

• Time their enrollment to avoid penalties
• Choose between employer coverage and Medicare
• Compare Medigap and Advantage plans based on real costs and needs

There’s a lot to consider—but you don’t have to figure it out alone. Let us guide you through the process so you can move forward with clarity and confidence.

The post Everything You Need to Know About Medicare Part A and What It Doesn’t Cover appeared first on ROI TV.